Eversion apparatus and methods

ABSTRACT

Surgical eversion apparatus for preparing a conduit for anastomosis in a human patient comprises an everting member having a loop shaped portion adapted to be inserted into an end portion of a conduit harvested from a human patient and configured to fold a portion of the conduit end portion over itself when moved proximally away from the end of the conduit and along the conduit while a portion of the conduit is held fixed relative thereto. A method of everting a graft comprises positioning a graft in a support device such that an end portion of the graft extends therefrom; introducing a generally looped shaped member into the end portion of the graft extending from said support device; and moving the looped shaped member over the support device to fold at least a portion of the end portion of the graft over the support device.

FIELD OF THE INVENTION

This invention relates to apparatus and methods for preparing a tubulargraft for an anastomosis procedure. More particularly, the inventioninvolves apparatus and methods for everting a graft prior toanastomosing the graft to another tubular structure such as an aorta.

BACKGROUND OF THE INVENTION

The occlusion of the arteries can lead to insufficient blood flowresulting in discomfort and risks of angina and ischemia. Significantblockage of blood flow in the coronary artery can result in damage tothe myocardial tissue or death of the patient. In most cases, occlusionof the artery results from progressive long term deposits of plaquealong the artery wall. While such deposits may be concentrated andocclude the artery at a particular site, the deposits are most certainlypresent throughout the arteries and the vascular system.

Coronary artery bypass graft (CABG) surgery is a surgical procedureperformed in severe cases of coronary blockages. CABG procedures involveanastomosing an artery to a graft, such as a vascular graft, whichrestores the flow of blood by establishing another pathway around theoccluded vasculature. During coronary artery bypass graft surgery, avein or other conduit can be attached proximally to the patient's aorta.The other end is attached to the blocked artery, downstream from theobstruction, thus bypassing the coronary occlusion. CABG procedures canbe done by placing the patient on a heart-lung machine and stopping theheart from beating or they can be done on a beating heart without aheart lung machine.

Vessel eversion apparatus have been disclosed to prepare vascular graftsfor anastomosis. For example, vessel everting apparatus is described inU.S. Pat. No. 5,076,161 to Kirsch, et al. and U.S. Pat. No. 6,176,413 toHeck, et al. However, there remains a need to provide improved evertingapparatus and methods.

SUMMARY OF THE INVENTION

The present invention involves improvements in anastomosis apparatus andmethods for anastomosing a first tubular structure to a second tubularstructure.

According to one embodiment of the invention, eversion apparatus forpreparing a conduit, such as a vessel, for anastomosis in a humanpatient comprises an everting member having a loop shaped portionadapted to be inserted into an end portion of a conduit from a humanpatient and configured to fold a portion of the conduit end portion overitself when it is moved away from the conduit end and along the conduitwhile a portion of the conduit is held fixed relative thereto.

The eversion apparatus facilitates eversion of a vascular or nonvasculargraft, for example, so that the intimal surface of the graft and theintimal surface of the target conduit, such as a vessel, can be placedin contact with one another for the anastomosis. The eversion apparatusalso facilitates rapid graft eversion which can expedite the anastomosisprocedure. In cases where the surgeon must complete the graft in aslittle time as possible due to the absence of blood flowing through avessel such as the aorta in a CABG procedure, this can be especiallyadvantageous. If blood flow is not promptly restored, sometimes in aslittle as 30 minutes, the tissues the artery supplies may experiencesignificant damage or necrosis.

According to another embodiment of the invention, a conduit or vesseleversion system for preparing a conduit or vessel for anastomosis in ahuman patient comprises a conduit or vessel support device having aproximal end and a distal end; and everting apparatus comprising aneverting member, the everting member having a loop shaped portionadapted to be inserted into a portion of a conduit or vessel to beprepared for an anastomosis in a human patient and evert the portion ofthe conduit or vessel over the conduit or vessel support device when theconduit or vessel is coupled to the support device with an end portionthereof extending from the distal end of the support device.

According to another embodiment of the invention, a method of everting agraft comprises positioning a graft in a support device such that an endportion of the graft extends therefrom; introducing a generally loopedshaped member into the end portion of the graft extending from saidsupport device; and moving the looped shaped member over the supportdevice to fold at least a portion of the end portion of the graft overthe support device

The above is a brief description of some deficiencies in the prior artand advantages of the present invention. Other features, advantages, andembodiments of the invention will be apparent to those skilled in theart from the following description, accompanying drawings, wherein, forpurposes of illustration only, specific forms of the invention are setforth in detail.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an eversion tool constructed accordingto the principles of the present invention;

FIG. 2 is a side elevational view of the eversion tool of FIG. 1;

FIGS. 3A and 3B are top plan views of the eversion too

of FIG. 1 where FIG. 3A shows the everting member or loop adjusted to afirst diameter and FIG. 3B shows the everting member or loop adjusted toa second larger diameter;

FIGS. 4A and 4B illustrate another embodiment of the eversion tool whereFIG. 4A shows the everting member or loop adjusted to a first diameterand FIG. 4B shows the everting member or loop adjusted to a secondlarger diameter;

FIG. 5 illustrates another embodiment of the eversion tool;

FIGS. 6A-6D schematically illustrate everting a graft vessel using theeversion tool of any one of FIGS. 1-5, where FIG. 6A illustratespresenting the distal end portion of the graft vessel in a graft supportdevice, FIG. 6B illustrates insertion of the eversion tool in the distalend portion of the graft vessel, FIG. 6C illustrates everting the distalend portion of the graft vessel, and FIG. 6D illustrates removing theeversion tool from the everted graft and graft support device;

FIGS. 7A-7D depicts another support or anastomosis device apparatus withwhich the eversion tool can be used, where FIG. 7A is a partialsectional view of the support device, FIG. 7B is an enlarged partialsectional view of the apparatus of FIG. 7A taken generally along line7B-7B; FIG. 7C shows the apparatus of FIG. 7A in a radially collapsedstate with the mandrel or slide retracted allowing the arms toprogressively move radially inward along the distal portion thereof; andFIG. 7D shows the apparatus of FIG. 7A in a radially expanded state withthe mandrel longitudinally extended toward the distal end of theapparatus urging the arms radially outward; and

FIGS. 7E-7H illustrate everting a graft vessel using the eversion toolof any one of FIGS. 1-5, where FIG. 7E illustrates presenting the distalend portion of the graft vessel in the graft support device of FIG. 7A,FIG. 7F illustrates insertion of the eversion tool in the distal endportion of the graft vessel, FIG. 7C illustrates everting the distal endportion of the graft vessel with the eversion tool, and FIG. 7Dillustrates extending piercing member through the distal end portion ofthe graft vessel after the eversion tool has been removed.

DETAILED DESCRIPTION OF THE INVENTION

Before the present invention is described, it is to be understood thatthis invention is not limited to the particular embodiments or examplesdescribed herein, as such may, of course, vary. Further, when referringto the drawings, like numerals indicate like elements.

The apparatus, systems, and methods described herein can be used toconnect or anastomose tubular structures or conduits together. Thetubular structures can be vascular or nonvascular structures. Thus, theapparatus, systems, and methods described herein can be used inconnection with coronary artery bypass grafting procedures during whicha vascular conduit or graft structure, such as a vein (e.g., a saphenousvein), artery (e.g., an internal mammary artery), or an artificialconduit or graft structure, is anastomosed to an aorta, the exampletarget structure. They also can be used in connection with theanastomosis of internal mammary arteries to coronary arteries, andsaphenous veins to coronary, femoral or popliteal arteries. Theapparatus, systems, and methods described herein also can be used inconnection with connecting other body lumens including nonvascularlumens, which can include, but are not intended to be limited to, thebile duct, the urethra, the urinary bladder, intestines, esophagus,stomach, and bowel.

The ideal anastomotic connection can be created when the componentvessels are arranged in a situation that provides intima-to-intimacontact. Standard suturing techniques provide some degree of thisattribute, but there are inconsistencies owing to, for example,variation in operator technique and vessel preparation. To ensureproviding exposure of the graft vessel intima, the vessel can be everted(or cuffed). This involves manipulation of the vessel to turn a definedsection inside-out to expose the internal lumen and intimal surface.This everted section can also be utilized to create a seal (or gasket)between the graft and the native vessel. The everted section can be usedto form the interface at the anastomotic site that also provides amedium for desired tissue healing. One difficulty of vessel eversionarises when attempting to manually manipulate the tissue to create theeverted section or cuff. As the tissue is semi-elastic, it has atendency to resist manual eversion.

The invention involves graft or vessel everting apparatus, systems andmethods to prepare grafts and vessels for anastomosis and assist withthe anastomosis. The eversion tool or apparatus of the present inventiongenerally comprises an everting member, which comprises a flexible orpliable member or portion. The flexible or pliable member or portion canbe semi-rigid and can be generally oval or circular with a closed ornearly closed turn. In other words, the flexible or pliable member orportion can be in the form of a loop. In operation, the everting memberloop is inserted into one end of a graft or vessel and then manipulatedto expand the graft or vessel radially outward so that the graft orvessel can be everted or draped over a vessel holder or support device,which will be described in more detail below. The everting member loopcan have variable shapes and/or diameters to accommodate variously sizedvessel support devices and to facilitate ease of its removal therefrom.The eversion tool also can include a handle to support the evertingmember.

Referring to FIGS. 1, 2, 3A, and 3B, one embodiment of an eversion toolconstructed in accordance with the principles of the present inventionis shown and generally designated with reference numeral 100. Eversiontool 100 generally comprises an everting member 104, which comprises aflexible or pliable member having a portion that is in the form of acircular loop. The generally circular loop can be nearly closed orclosed. It should be understood, however, the flexible and/or pliablecharacteristics allow the loop to be readily reshaped. One suitablematerial for flexible or pliable member 104 can be stainless steel wire,such as 304 series stainless steel wire, or nitinol wire. The wiretypically will have a diameter ranging from about 0.002 to 0.015 inch.

In the illustrative embodiment, eversion tool 100 includes handle 102for supporting everting member 104. As shown in the illustrativeembodiments, handle 102 can be tubular. It also can have a collar at itsdistal end as shown in FIGS. 7E-G. The handle can be made from anysuitable material such as a machined metal (e.g., stainless steel) orinjection molded plastic.

In the embodiment illustrated in FIGS. 3A and 3B, everting member 104 isslidably mounted in handle 102. More specifically, the ends of astraight wire (e.g., a nitinol wire) can be brought together andinserted into the handle without platically deforming the wire. Thisfacilitates adjustment of the size of the everting member loop extendingfrom handle 102 by moving the ends of the wire. One can move proximallylocated everting member ends 104 a and 104 b relative to handle 102 toadjust the length of the elongated everting member portion extendingfrom the distal end of handle 102 to adjust the loop size. In FIG. 3A,the distal ends 104 a and 104 b are in first position and in FIG. 3Bthey have been moved in a distal direction as shown with arrows toenlarge the loop diameter from a first diameter D1 to a second largerdiameter D2. From the position shown in FIG. 3B, either one or both ofthe distal ends can be moved proximally to return the loop diametertoward or to D1 or make the loop smaller than D1.

Referring to FIGS. 4A and 4B another embodiment of the eversion tool isshown and generally designated with reference numeral 100′. Eversiontool 100′ is the same as eversion tool 100 with the exception that oneportion of everting member 104 is fixedly secured to handle 102. In theexample illustrated in FIGS. 4A and 4B, everting member 104 b is fixedlysecured to handle 102. Accordingly, one can enlarge the everting memberloop diameter DI as shown in FIG. 4A by moving or sliding evertingmember end 104 a in a distal direction as shown with the arrow in FIG.4B to enlarge the diameter D1 to D2. One can retract everting member end104 a to return the loop diameter toward or to D1 or reduce the loopdiameter to a diameter less than D1. According to further variations,the loop can be preformed with other shapes such as oblong, oval orteardrop shapes.

Referring to FIG. 5, another embodiment of the eversion tool is shownand generally designated with reference numeral 100″. Eversion tool 100″is the same as eversion tool 100 with the exception that two portions ofeverting member 104 are fixedly secured to handle 102 so that the lengthof the loop extending from the distal end of the handle is fixed. In theillustrative embodiment, everting member ends 104 a and 104 b can befixedly secured to handle 102.

Referring to FIGS. 6A-D, operation of the eversion tool will bedescribed in conjunction with a graft support device which isschematically shown and generally indicated with reference numeral 200.In order to assist in the understanding of the operation of the eversiontool, graft support device 200 will first be described.

Anastomosis or support device 200 is used to hold the everted grafttubular structure (e.g., graft vessel) adjacent to or in an openingformed in a target tubular structure (e.g., target vessel) to which thegraft tubular structure is to be anastomosed. More specifically, thesupport device supports or holds the graft tubular structure in aposition relative to the target tubular structure so that the graft andtarget tubular structure can be secured to one another with knownfasteners such as sutures or surgical clips.

Anastomosis or support device 200 comprises a proximal portion and adistal portion. The distal portion has a plurality of arms (or fingers)206 that are configured to hold the everted portion or flap “E” of atubular graft structure “G” as shown in FIGS. 6C and 6D. Adjacent armsare configured and arranged to form spaces, such as spaces 208, suitablefor receiving surgical fasteners therethrough. Support device 200 can bedescribed as a slotted tubular member, each slot having an open distalend and a closed end. After the support device has been positioned inthe desired position and fasteners passed through a desired number ofthe slots through graft tubular structure and the target tubularstructure, the open ends allow removal of the anastomosis or supportdevice without disrupting the fasteners.

Anastomosis device or support 200 can be made from any suitable plasticor metal. For example, the device can be made from ABS plastic materialor stainless steel tubing such as 304 stainless steel tubing. The lengthof the device typically ranges from about 25 mm to about 125 mmdepending on the application. In aortic applications, it typicallyranges from about 25 mm to about 70 mm. The inner diameter of the tubetypically ranges from about 1 mm to about 25 mm also depending on theapplication. For example, the inner diameter typically can vary fromabout 3 mm to about 6 mm when sized for an aortic anastomosis where thetube thickness can range from 0.1 mm to 2 mm. On the other hand, thetube inner diameter can be up to about 25 mm when sized for applicationsconcerning the bowel. The tube can have any number of slots or openings,but typically will have 4 to 12 slots cut into its side or the number ofarms selected and arranged to form 4 to 12 openings. The slots oropenings typically extend a length of about 2 mm to about 25 mm and havea width of about 0.2 mm to about 5 mm. In aortic applications, the slotlength typically can range from about 5 mm to about 25 mm and the slotwidth typically can range from about 0.2 mm to 2.5 mm. The desirednumber of sutures or clips to be used for a particular anastomosis candetermine the number of spaces or slots that the anastomosis deviceshould have. That is the number of openings can match the number desiredfasteners. However, it should be understood that the number of openingsneed not necessarily match the number of fasteners.

The tube can be split down the side to facilitate its placement in andremoval from the tubular graft structure. Regarding the former, thesplit allows the tube to be compressed and deformed to fit into smallopenings in the target vessel. On the other hand, the split can beexpanded to assist in removing the graft from the device. The tube cancomprise or be made of shape memory material or alloy so that thecompressed split tube returns to a shape memory tubular shape that isapproximately equal to or slightly larger the opening into which it isinserted. The tube construction can provide for some elastic deformationin the radial direction if radially compressed so that its annulardimension can be decreased to some degree, which can be desirable whenintroducing the device into an opening formed in a vessel where theopening is slightly smaller in diameter than the diameter of device 200in the uncompressed state. The wall thickness can be selected (e.g.,reduced) to provide such elastic deformation. Other factors that can beused to achieve this effect include, but are not limited to a slotnumber, slit width, and material selection as would be apparent to oneof skill in the art. For example, the tubular member can comprise or bemade of nitinol.

Support device 200 can be cylindrical as shown in the drawings or it canhave other shapes suitable for the intended purpose. For example, it canhave a rectangular or oval configuration. Other construction examplesinclude, but are not limited to, mesh tubes, wire framed constructions,or other nonsolid wall constructions.

Referring to FIG. 6A, tubular graft structure (e.g., graft vessel) “G”is passed between adjacent fingers 206 of support device 200 and thedistal end thereof positioned to extend distally from the support devicelumen. Alternatively, the tubular graft structure can be presentedthrough the proximal end of support device 200 so that it passes alongthe length of the support device and extends from both the distal andproximal ends thereof. Eversion tool 100 or 100′ is prepared forinsertion into the distal end of the tubular graft structure. This caninclude bending the everting member portion that extends from handle 102so that the plane in which the everting member loop lies forms an angleof about 90 degrees with the longitudinal axis of the handle as shown inFIG. 6A. The everting member loop is adjusted to have a diameter thatallows it to be readily inserted into the end of graft G. The loopdiameter can be selected to be less than the inner diameter of the endof graft G as shown in FIG. 6A. The everting member loop diameter isthen enlarged to mechanically expand graft G, which in this example issemi-elastic, and increase the diameter of the graft as shown in FIG.6B. The eversion tool is then moved so that the everting member passesover the distal end of the support device, thereby mechanically drapingthe expanded end of the graft over the support device distal end asshown in FIG. 6C. With the graft everted over support device 200, theeversion tool can be retracted as shown in FIG. 6D. Optionally, one candetach one end of everting member 104 from handle 102 for easier removal(FIG. 6D).

When eversion tool 100′ is used with a fixed loop length, one typicallydoes not bend the everting member to form an angle with handle 102. Inthis case, the loop is inserted into the graft and pulled over the graftsupport device as shown in FIGS. 7E-G, which will be described in detailbelow.

FIGS. 7A-D illustrate a support device 700 that also can be used inconjunction with eversion tool or apparatus 100, 100′, or 100′″ inaccordance with the principles of the present invention. Support device700 is described in co-pending U.S. patent application Ser. Nos.10/340,161 and 10/340,164, both of which were filed on Jan. 10, 2003 andentitled Anastomosis Apparatus and Methods.

Anastomosis or graft support device 700 generally includes a proximalportion and a distal portion, which includes a plurality of arms 706 inwhich piercing members 710 can be slidably mounted. More specifically,each arm forms a pathway in which a piercing member 710 is slidablymounted. Arms 706 can be tubular members (e.g., hypotubes) each having alumen through which a piercing member 706 can slide.

Arms 706 are biased radially inward and have outer diameters that canrange from 0.5 mm to 2 mm, for example, in aortic applications. In theillustrative embodiment, anastomosis apparatus 700 includes a mandrel orslide 722 for radially expanding the piercing member carrying or supportarms 706.

Each arm 706 has a proximal end secured to tubular member or arm support720 which tapers so that the annular dimension of the arms, takencollectively, progressively decreases in the distal direction when theslide 722 is in a retracted position adjacent to arm support 720 asshown in FIG. 7A. The arms can be secured in circumferentially spacedlongitudinal grooves formed in arm support 720 by gluing or othersuitable means. The arms also extend along longitudinal grooves formedin mandrel or slide 722. Actuator or plunger 718 extends through thedevice with its end secured to mandrel or slide 722 so that when thepusher is moved forwardly, it pushes the mandrel or slide 722 distallyand radially expands the arms. After a graft is everted over the distalends of the arms as will be described below, it can be desirable toradially expand the arms when graft holder or support 700 is positionedin an opening in a target tubular structure (e.g., target vessel) towhich the tubular graft structure (e.g., graft vessel) is to beanatomosed. The radial expansion of the arms can enhance or form a sealbetween the graft and the target tubular structure (e.g., an aorta).

Referring to FIGS. 7C and 7D, apparatus or device 700 further includespiercing members 710, which are slidably mounted in arms 706. Piercingmembers 710 have proximal portions 710 a and distal portions 710 b.Piercing members 710 extend from arms 706 proximally toward cylindricalpiercing member support 721 where proximal portions 710 a are secured ingrooves formed in cylindrical piercing member support 721. Support 721is slidably mounted on actuator or pusher 718 and secured to cylindricalknob or finger grip 714 by fastener or screw 716 (FIG. 7B). When knob714 is pushed forwardly in a distal direction, the piercing members areextended as shown in FIGS. 7C and 7D. Moving the knob 714 proximallyretracts the piercing members as shown in FIG. 7A. Housing or tubularbody 712 can have a longitudinal slot 717 through which screw 716 canslide so that knob 714 can move independently from housing 712.

The radius of curvature of the memory shaped distal portions 710 b ofthe piercing members can vary. For example, a larger radius of curvaturemay be desired if the user wants to insert part of the device into theopening in the target structure or vessel to which the graft is to beanastomosed. On the other hand, a smaller radius of curvature may bedesired if the user wants to tack the device down around the opening inthe target structure or vessel, thereby seating the device on the outerwall and covering the opening with the graft.

Distal portions 710 b have the desired memory shape to pierce the graftand vessel to which the graft is to be anastomosed when the piercingmembers are advanced. In the illustrative embodiment, the piercingmembers comprise shape memory material so that the distal portions 710 bcan be provided with a hook configured memory shape, which is onesuitable shape for holding the graft and vessel together during theanastomosis. Thus, the piercing members can be made of nitinol wire andthe distal portions provided with the desired memory shape as is knownin the art so that they return to their memory shape when in an unbiasedstate (e.g., extended from arms 706). In other words, the shape memoryalloy distal portions exhibit pseudoelastic (superelastic) behavior.

Referring to FIGS. 7E-G, eversion of a graft over the distal end portionof support member or apparatus 700 using any one of the eversion tools100, 100′, or 100″ will be described. Graft structure (e.g., graftvessel) G is positioned in the graft support device or apparatus 700with the distal end of graft structure G extending from the distal endof the support device as shown in FIG. 7E. The everting member loop ofeversion tool 100 is introduced through the distal end of the graftstructure and inserted into the graft lumen shown in FIG. 7F. Thediameter of the everting member or loop can be increased as describedabove in connection with embodiments 100 and 100′ to expand or increasethe diameter of the graft vessel to make it easier to evert the distalend portion of the graft structure over the distal end of the graftholding device. The everting member loop is then turned or oriented sothat it can pass over the distal end portion of the support member andmoved to pass over the support member distal end portion or arms 706,thereby everting graft structure G over the support member distal endportion and forming everted portion E with the intimal surface of thegraft lumen exposed and facing radially outward. In this manner thegraft is prepared for an anastomosis where an intima-to-intimaconnection can be readily achieved. The support device can be positionedin an opening formed in the target tubular structure and the piercingmembers extended as shown in FIG. 7H to hold the graft and targettubular structures together, while fasteners are used to secure thegraft and target structures together.

More specifically, after the surgeon cuts a hole or opening in thetarget tubular structure or vessel (e.g., the aorta) using a scalpel andan aorta cutting device or punch, the surgeon covers the hole witheither a finger or other suitable tool. The distal portion of thesupport device and the portion of the graft everted thereover arepositioned in the vessel opening. The distal portions of the piercingmembers are extended and the mandrel is moved distally to expand thearms and everted graft against the tissue surrounding the opening so asto form a seal therewith. In other words, the arms can be expanded tourge the everted graft against the tissue surrounding the target vesselopening to seal the connection between the graft and target vessel.After the fasteners have been placed to connect the graft and targettubular structures, the piercing members are retracted and anastomosisdevice 700 pulled off of the graft and target structures. Additionalfasteners or clips can be placed at the connection, if any blood appearsto be seeping out from the graft and target vessel.

Any fastener can be used to secure the tubular graft and targetstructures together. Examples of suitable fasteners include conventionalsutures and surgical clips such as the surgical clips disclosed in U.S.Pat. Nos. 5,972,024 to Northrup, et al., 6,607,541 to Gardiner, et al.,6,514,265 to Ho, et al., U.S. Patent Publication No. 2002-0010490 ofU.S. patent application Ser. No. 09/260,623 filed Mar. 1, 1999 andentitled Tissue Connector Methods and Apparatus and U.S. patentapplication Ser. No. 09/090,305 filed Jun. 3, 1998 and entitled TissueConnector Apparatus and Methods.

Variations and modifications of the devices and methods disclosed hereinwill be readily apparent to persons skilled in the art. As such, itshould be understood that the foregoing detailed description and theaccompanying illustrations, are made for purposes of clarity andunderstanding, and are not intended to limit the scope of the invention,which is defined by the claims appended hereto.

1. Surgical eversion apparatus for preparing a conduit for anastomosisin a human patient, said eversion apparatus comprising an evertingmember having a loop shaped portion adapted to be inserted into an endportion of a conduit from a human patient and configured to fold aportion of the conduit over itself when it is moved away for the conduitend and along the conduit while a portion of the conduit is held fixedrelative thereto.
 2. The eversion apparatus of claim 1 wherein saideverting apparatus includes a handle and said everting member is coupledto said handle.
 3. The eversion apparatus of claim 2 wherein saideverting member comprises a flexible member having two ends, said twoends being movable relative to said handle and portions of said flexiblemember being slidably mounted to said handle.
 4. The eversion apparatusof claim 2 wherein said everting member comprises a flexible memberhaving two ends, one of said ends being movable relative to said handle,the other one of said two ends being fixedly secured to said handle. 5.The eversion apparatus of claim 2 wherein said everting member comprisesa flexible member having two ends, both of said ends being fixedlyattached to said handle.
 6. The eversion apparatus of any one of claims3-5 wherein said flexible member comprises a pliable wire.
 7. Theeversion apparatus of claim 1 wherein said loop shaped portion has anadjustable diameter.
 8. A vessel eversion system for preparing a vesselfor anastomosis in a human patient, said vessel eversion systemcomprising: a vessel support device having a proximal end and a distalend; and everting apparatus comprising an everting member, said evertingmember having a loop shaped portion adapted to be inserted into aportion of a vessel to be prepared for an anastomosis in a human patientand evert the portion of the vessel over said vessel support device whensaid vessel is coupled to said support device with an end portionthereof extending from said distal end of said support device.
 9. Thevessel eversion system of claim 8 wherein said everting apparatusincludes a handle and said everting member is coupled to said handle.10. The vessel eversion system of claim 9 wherein said everting membercomprises a flexible member having two ends, said two ends being movablerelative to said handle and portions of said flexible member beingslidably mounted to said handle.
 11. The vessel eversion system of claim9 wherein said everting member comprises a flexible member having twoends, one of said ends being movable relative to said handle, the otherone of said two ends being fixedly secured to said handle.
 12. Thevessel eversion system of claim 9 wherein said everting member comprisesa flexible member having two ends, both of said ends being fixedlyattached to said handle.
 13. The vessel eversion system of any one ofclaims 10-12 wherein said flexible member comprises a pliable wire. 14.The vessel eversion system of claim 8 wherein said loop shaped portionhas an adjustable diameter.
 15. A method of everting a graft comprising:positioning a graft in a support device such that an end portion of thegraft extends therefrom; introducing a generally looped shaped memberinto the end portion of the graft extending from said support device;and moving the looped shaped member over the support device to fold atleast a portion of the end portion of the graft over the support device.16. The method of claim 15 including adjusting the generally loopedshaped member to have a diameter less than the diameter of the graft endthrough which it is introduced before introduction therein.
 17. Themethod of claim 16 including adjusting the generally looped shapedmember after it is introduced through the graft end to have a diametergreater than the graft end through which it is introduced.
 18. Themethod of claim 15 including adjusting the generally looped shapedmember to have a diameter greater than the graft end into which it isinserted.
 19. The method of claim 15 including radially expanding thegraft portion.
 20. The method of claim 15 wherein positioning the graftcomprises positioning a tubular vascular graft in a support device.